Vaccine coverage in PLWH: disparities and potential impact of vaccine hesitancy

BACKGROUND World Health Organization declared the vaccine hesitancy as a global public health threat in 2019. Since even a slight reduction in vaccine coverage rates can lead to a decrease in herd immunity, it is imperative to explore the underlying factors affecting vaccine hesitancy. in specific contexts, considering socioeconomic and cultural variation, to ensure interventions targeting hesitancy are well formulated and intervened. OBJECTIVE The main objective of this study is to identify underlying factors affecting vaccine hesitancy in Iran. METHODS A framework qualitative study will be conducted in the west of Tehran province in 2020. Participants in the study will be recruited hesitance-parents who extracted from the SIB system (an electronic health record in Iran) to maximize diversity. Interviews will be analyzed based on ''Determinants of Vaccine Hesitancy Matrix'' which developed by the WHO-SAGE Working Group. RESULTS deep understanding from the context-specific reasons for vaccine hesitancy cause to formulate better strategies to address them. The ultimate goal of this study is to inform future policies to increase the uptake of the vaccine in Iran. CONCLUSIONS This result of study will show variety opinions about vaccination among different types of socioeconomic and demographic households. The wide range of reasons related to vaccine hesitancy imply to more comprehensive, context-specific interventions. Today, the most important intervention issues focus on improving information about effectiveness and safety of vaccines, while other interventions for promoting vaccination is need to addressed.

Download Full-text

Intention to Be Vaccinated for COVID-19 among Italian Nurses during the Pandemic

Vaccines ◽

10.3390/vaccines9050500 ◽

2021 ◽

Vol 9 (5) ◽

pp. 500

Author(s):

Marco Trabucco Aurilio ◽

Francesco Saverio Mennini ◽

Simone Gazzillo ◽

Laura Massini ◽

Matteo Bolcato ◽

...

Keyword(s):

Vaccine Efficacy ◽

Online Survey ◽

Vaccine Development ◽

Vaccine Coverage ◽

World Health ◽

Vaccine Hesitancy ◽

Effective Vaccine ◽

Online Questionnaire ◽

Cross Sectional ◽

Female Sex

Background: While the COVID-19 pandemic has spread globally, health systems are overwhelmed by both direct and indirect mortality from other treatable conditions. COVID-19 vaccination was crucial to preventing and eliminating the disease, so vaccine development for COVID-19 was fast-tracked worldwide. Despite the fact that vaccination is commonly recognized as the most effective approach, according to the World Health Organization (WHO), vaccine hesitancy is a global health issue. Methods: We conducted a cross-sectional online survey of nurses in four different regions in Italy between 20 and 28 December 2020 to obtain data on the acceptance of the upcoming COVID-19 vaccination in order to plan specific interventions to increase the rate of vaccine coverage. Results: A total of 531 out of the 5000 nurses invited completed the online questionnaire. Most of the nurses enrolled in the study (73.4%) were female. Among the nurses, 91.5% intended to accept vaccination, whereas 2.3% were opposed and 6.2% were undecided. Female sex and confidence in vaccine efficacy represent the main predictors of vaccine intention among the study population using a logistic regression model, while other factors including vaccine safety concerns (side effects) were non-significant. Conclusions: Despite the availability of a safe and effective vaccine, intention to be vaccinated was suboptimal among nurses in our sample. We also found a significant number of people undecided as to whether to accept the vaccine. Contrary to expectations, concerns about the safety of the vaccine were not found to affect the acceptance rate; nurses’ perception of vaccine efficacy and female sex were the main influencing factors on attitudes toward vaccination in our sample. Since the success of the COVID-19 immunization plan depends on the uptake rate, these findings are of great interest for public health policies. Interventions aimed at increasing employee awareness of vaccination efficacy should be promoted among nurses in order to increase the number of vaccinated people.

Download Full-text

Knowledge, Attitude, and Practice of Physicians Regarding Vaccinations in Yerevan, Armenia: A Case Study of HPV

Vaccines ◽

10.3390/vaccines9101188 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1188

Author(s):

Arman R. Badalyan ◽

Marine Hovhannisyan ◽

Gayane Ghavalyan ◽

Mary M. Ter-Stepanyan ◽

Rory Cave ◽

...

Keyword(s):

Cervical Cancer ◽

Vaccine Coverage ◽

Medical Knowledge ◽

Hpv Infection ◽

Healthcare Sector ◽

Vaccine Hesitancy ◽

Primary Data ◽

Cross Sectional ◽

New Vaccines

This paper highlights the low levels of vaccine coverage and high levels of reported vaccination hesitancy in Yerevan, Armenia, that present profound challenges to the control of disease through routine vaccination programmes. We draw on investigations of hesitancy towards the introduction of new vaccines, using the Human Papillomavirus (HPV) vaccine Gardasil as a case study, to interrogate underlying challenges to vaccine acceptance. We analyse primary data from the introduction of Gardasil, first used in Armenia in 2017, to investigate how levels of medical knowledge amongst physicians in 20 health facilities in Yerevan, Armenia, regarding vaccine science influence attitudes towards the introduction of a newly developed vaccine. A questionnaire-based cross-sectional study was completed by 348 physicians between December 2017 and September 2018. The responding physicians displayed a respectable level of knowledge and awareness regarding vaccination with respect to some characteristics (e.g., more than 81% knew that HPV infection was commonly asymptomatic, 73% knew that HPV infection was implicated in most cervical cancers, and 87% knew that cervical cancer is the most prevalent cancer amongst women) but low knowledge and poor understanding of other key issues such as the age at which women were most likely to develop cervical cancer (only 15% answered correctly), whether or not the vaccine should be administered to people who had already been infected (27% answered correctly) and whether sexually active young people should be treated for infection before vaccination (26% answered correctly). The study suggests that the drivers of vaccine hesitancy are complex and may not be consistent from vaccine to vaccine. The Armenian healthcare sector may need to provide additional training, awareness-raising and educational activities alongside the introduction of new vaccines to improve understanding of and trust in vaccination programmes.

Download Full-text

A Community-Based Management of COVID-19 in a Mobile Container Unit

Vaccines ◽

10.3390/vaccines9111362 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1362

Author(s):

Elena Petrova ◽

Timothy Farinholt ◽

Tejas P. Joshi ◽

Hannah Moreno ◽

Mayar Al Mohajer ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Coverage ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Air Filtration ◽

Clinical Environment ◽

Mobile Clinic ◽

Community Based ◽

Community Healthcare

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

Download Full-text

Vaccine hesitancy in India-the challenges: a review

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20204768 ◽

2020 ◽

Vol 7 (11) ◽

pp. 4643

Author(s):

Gopalakrishnan S. ◽

Sujitha P.

Keyword(s):

Vaccine Coverage ◽

Evaluation Studies ◽

Cost Effective ◽

Vaccine Hesitancy ◽

Universal Immunization Program ◽

Vaccine Preventable Diseases ◽

Immunization Programme ◽

Childhood Morbidity ◽

National Immunization Programme ◽

Urban Rural

Immunization is the most cost-effective scientific method of reducing childhood morbidity and mortality. In India the national immunization programme has not been able to attain complete coverage of the eligible children and hence mortality due to vaccine preventable diseases is approximately 5 lakhs annually. Every year, 89 lakhs children are at risk to develop vaccine preventable diseases due to lack of immunization. While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay, hesitant or refuse vaccines due to various reasons. Despite the realization of compulsory scheduling of vaccines, there are an alarming number of parents who do not permit the vaccination of their children as scheduled. Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite the availability of vaccination services. WHO in 2019 listed vaccine hesitancy as one of the ten global health threats. The recent vaccination coverage evaluation studies have shown that there is a perceptible drop in the vaccine coverage in most parts of India and also that the disparity in the urban-rural coverage is also widening. Hence an evaluation of the reasons for vaccine hesitancy is vital at present to strengthen the universal immunization program. The authors are trying to trace the present status and reasons for vaccine hesitancy reported in recent times, which can lead to outbreaks of already controlled vaccine preventable diseases and to identify strategies which are being implemented to overcome the vaccine hesitancy.

Download Full-text

The acceptance of covid-19 vaccines in Sub-Saharan Africa: Evidence from 6 national phone surveys

10.1101/2021.06.28.21259320 ◽

2021 ◽

Author(s):

Shelton Kanyanda ◽

Yannick Markhof ◽

Philip Wollburg ◽

Alberto Zezza

Keyword(s):

Side Effects ◽

Low Income ◽

Urban Areas ◽

Vaccine Coverage ◽

Sub Saharan Africa ◽

Low Income Countries ◽

Vaccine Hesitancy ◽

African Countries ◽

Representative Sampling ◽

Sub Saharan

Introduction Recent debates surrounding the lagging covid-19 vaccination campaigns in low-income countries center around vaccine supply and financing. Yet, relatively little is known about attitudes towards covid-19 vaccines in these countries and in Africa in particular. In this paper, we provide cross-country comparable estimates of the willingness to accept a covid-19 vaccine in six Sub-Saharan African countries. Methods We use data from six national high-frequency phone surveys from countries representing 38% of the Sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria, and Uganda). Samples are drawn from large, nationally representative sampling frames providing a rich set of demographic and socio-economic characteristics by which we disaggregate our analysis. Using a set of re-calibrated survey weights, our analysis adjusts for the selection biases common in remote surveys. Results Acceptance rates in the six Sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects emerge as the primary reservations toward a covid-19 vaccine across countries. Conclusions Our findings suggest that limited supply, not inadequate demand, likely presents the key bottleneck to reaching high covid-19 vaccine coverage in Sub-Saharan Africa. To turn intent into effective demand, targeted communication campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world's poorest regions.

Download Full-text

1620. Effectiveness of the 2016 California Policy Eliminating Non-Medical Exemptions on Vaccine Coverage: A Synthetic Control Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1484 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S591-S591

Author(s):

Sindiso Nyathi ◽

Hannah Karpel ◽

Kristin L Sainani ◽

Yvonne Maldonado ◽

Peter J Hotez ◽

...

Keyword(s):

Control Method ◽

Vaccine Coverage ◽

The United States ◽

State Policies ◽

Vaccine Hesitancy ◽

Control Analysis ◽

Synthetic Control ◽

Permutation Testing ◽

Personal Belief ◽

Post Period

Abstract Background Vaccine hesitancy in low vaccine coverage “hot spots” has led to recent outbreaks of vaccine-preventable diseases across the United States. State policies to improve vaccine coverage by restricting non-medical (personal belief) exemptions are heavily debated and their effectiveness is unclear due to limited rigorous policy analysis. In 2016, a California policy (SB 277) eliminated non-medical exemptions from kindergarten requirements. To address the ongoing debate on such policies, we performed a quasi-experimental, controlled analysis of the policy’s impact on vaccine and exemption outcomes. Methods We used state vaccine coverage and exemption data (2011–2017) from the CDC and health data from public sources. We prespecified a primary outcome of MMR coverage (%) and secondary outcomes of medical and non-medical exemptions (%). We included covariates related to socioeconomic and health measures (e.g., insurance, well child visits) and pre-2016 mean coverage. Using the synthetic control method, with 2016 as the treatment year and a 2-year post-policy period, we constructed a “control” California, from a weighted sum of states. We used permutation testing to repeat the process for each of the other states and their unique synthetic control, to determine whether there was a meaningful difference in California (i.e., a change in California’s coverage relative to its control in the top 5th percentile of states). We tested the model’s sensitivity to various analytical assumptions. Results Of 43 control states, synthetic California was predominantly comprised of Idaho, Mississippi, and Arkansas, and had a good pre-policy match on outcomes. MMR coverage in California increased by 3.2% relative to synthetic California in the post period (Top 1 of 44 states, Figure 1). Medical exemptions increased by 0.4%, while non-medical exemptions decreased by 2.2% in the post-period (Top 1 of 43 states). The model was robust to changes in covariates and control states. Conclusion The policy resulted in a meaningful increase in MMR coverage and reduction in non-medical exemptions. We measured a modest increase in medical exemptions, but this was offset by the larger reduction in non-medical exemptions. State policies removing non-medical exemptions can be effective in increasing vaccination coverage. Disclosures All authors: No reported disclosures.

Download Full-text

Parental concerns and uptake of childhood vaccines in rural Tanzania – a mixed methods study

BMC Public Health ◽

10.1186/s12889-020-09598-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lavanya Vasudevan ◽

Joy Noel Baumgartner ◽

Sara Moses ◽

Esther Ngadaya ◽

Sayoki Godfrey Mfinanga ◽

...

Keyword(s):

Mixed Methods ◽

Vaccine Coverage ◽

Mitigation Strategies ◽

Mixed Methods Study ◽

Sub Saharan Africa ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Parental Concerns ◽

Childhood Vaccines

Abstract Background Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania. Methods Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards. Results In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage. Conclusions Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies.

Download Full-text

Pharmacists’ one-to-one counseling succeeds in promoting flu shots among target population

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.031 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Brunelli ◽

A Morsanutto ◽

M Tosolini ◽

A Iob ◽

F Schiava ◽

...

Keyword(s):

At Risk ◽

Influenza Vaccination ◽

Vaccine Coverage ◽

Vaccination Campaign ◽

Target Population ◽

Vaccine Hesitancy ◽

Vaccine Preventable Diseases ◽

Counseling Intervention ◽

Flu Vaccination ◽

One To One

Abstract Background Vaccine hesitancy among general population can be even greater regarding flu than other vaccine preventable diseases, as complacency towards influenza is quite high and confidence can be reduced by the confounding effect of influenza-like-illnesses. Health professionals face hesitant people alleging many different motivations against flu vaccination, some of them being susceptible to tailored one-to-one health promotion. Methods During 2019/20 flu vaccination campaign, 44 trained pharmacists of Carnia District in Friuli Venezia Giulia Region (Italy) surveyed at-risk people accessing 25 pharmacies regarding beliefs on flu vaccination and offered one-to-one advice. As stated in the Italian national vaccination plan, subjects with comorbidities or older than 65 were considered at risk. Adherence to influenza vaccination during past flu season and reasons for that choice, as well as intention to be administered flu shots after counseling were registered. Results A total of 2,748 at-risk subjects adhered to the project with a mean age of 70±12 years, 57% of them being females; 1,702 (38%) did not adhere to flu vaccination campaign last year. Most of them confirmed a low complacency level, reporting to have refused flu vaccination because of “not getting ill” (43%) believing that vaccines are dangerous (12%) or not effective (5%); some did not know they could access flu vaccination (8%). After counseling, 2196 (80%) decided to adhere to flu vaccination, in particular 83% (1284/1555) of over 65 and 84% (684/816) of at-risk subjects. Conclusions More than one third of over 65 or at-risk surveyed subjects did not receive influenza vaccination during 2018/19 flu season. One-to-one tailored counseling conducted by pharmacists resulted to be effective in tackling vaccine hesitancy among 2019/20 flu shot target population. Key messages Motivations underlying vaccine hesitancy toward flu vaccination continue to impair health outcomes of target population. A one-to-one counseling intervention conducted by pharmacists with specific targets should be useful to improve seasonal flu vaccine coverage.

Download Full-text

Towards a further understanding of measles vaccine hesitancy in Khartoum state, Sudan: A qualitative study

10.1101/568345 ◽

2019 ◽

Author(s):

Majdi M. Sabahelzain ◽

Mohamed Moukhyer ◽

Eve Dubé ◽

Ahmed Hardan ◽

Hans Bosma ◽

...

Keyword(s):

Vaccine Coverage ◽

Mode Of Delivery ◽

Vaccine Hesitancy ◽

Measles Vaccine ◽

Care Providers ◽

Structured Interviews ◽

Main Determinants ◽

Expanded Program On Immunization ◽

Context Specific ◽

Measles Outbreaks

AbstractBackgroundVaccine hesitancy is one of the contributors to low vaccination coverage in both developed and developing countries. Sudan is one of the countries that suffers from low measles vaccine coverage and from measles outbreaks. For a further understanding of measles vaccine hesitancy in Sudan, this study aimed at exploring the opinions of Expanded Program on Immunization officers at ministries of health, WHO, UNICEF and vaccine care providers at Khartoum-based primary healthcare centers.MethodsQualitative data were collected using semi-structured interviews during the period January-March 2018. The topic list for the interviews was developed and analyzed using the framework “Determinants of Vaccine Hesitancy Matrix” that developed by the WHO-SAGE Working Group.FindingsThe interviews were conducted with 14 participants. The majority of participants confirmed the existence of measles vaccine hesitancy in Khartoum state. They further identified various determinants that grouped into three domains including contextual, groups and vaccination influences. The main contextual determinant as reported is the presence of “anti-vaccination”; who mostly belong to some religious and ethnic groups. Parents’ beliefs about prevention and treatment from measles are the main determinants of the group influences. Attitude of the vaccine providers, measles vaccine schedule and its mode of delivery were the main vaccine related determinants.ConclusionMeasles vaccine hesitancy in Sudan appears complex and highly specific to local circumstances. To better understand the magnitude and the context-specific causes of measles vaccine hesitancy and to develop adapted strategies to address them, there is a need to investigate measles vaccine hesitancy among parents.

Download Full-text